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An Approach to Visual Loss in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Muhammad Hassaan Ali, Stacy L. Pineles
Any child who presents with photophobia, lacrimation and blepharospasm should be strongly suspected to have congenital glaucoma unless proved otherwise. Glaucoma in children usually occurs due to angle dysgenesis and is often associated with other congenital ocular abnormalities like Peter's and Rieger's anomaly (37,38). All children with congenital glaucoma should undergo regular testing for IOP, corneal diameter, anterior segment examination, cup to disc ratio and axial length measurement. Out of all these parameters, the corneal diameter is the most reliable indicator of severity of the glaucoma in children. A corneal diameter of greater than 14 mm indicates advanced buphthalmos and an advanced stage of the disease. Another characteristic feature of infantile glaucoma is the possibility of reversal of cup to disc ratio once pressure of the eye is controlled. Infantile glaucoma if not treated early may cause complete blindness in children. The treatment of choice is mostly surgical with goniotomy performed in eyes with clear corneas and angle filtration surgery preferred in eyes with hazy corneas (39). Complicated cases with failed filtration surgeries are usually treated with glaucoma shunt devices (40). Lastly, clinicians should always offer genetic counseling to the parents if more than one sibling gets affected.
Newborn and infant physical examination (NIPE)
Published in Alison Edwards, Postnatal and Neonatal Midwifery Skills, 2020
Check for congenital glaucoma. This affects around 1 in 10,000 babies and occurs due to a failure to drain fluid away caused by damage within the eye. Can be inherited. The baby is often sensitive to light with cloudy, watery eyes.
Optic nerve
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
Congenital glaucoma is a rare form of glaucoma — a condition that is usually acquired. It is most frequently bilateral and asymmetrical, affecting boys slightly more than girls. It occurs sporadically or can be inherited. In congenital glaucoma, the anterior chamber angle and trabecular meshwork do not develop correctly leading to poor drainage of acqueous fluid and subsequent build of high intraocular pressure. As the sclera in young infants is malleable, the eye enlarges with the high pressure (buphthalmos).
Illuminated Microcatheter Passage Assisted Circumferential Trabeculotomy and Trabeculectomy (IMPACTT): An improved surgical procedure for Primary Congenital Glaucoma
Published in Seminars in Ophthalmology, 2022
The patient was a 4-month-old child, product of a normal pregnancy and his birth weight was 3 kg. The parents noticed gradual enlargement of the eyes with intolerance to light and tearing from the eyes since the second months of birth. They consulted a general ophthalmologist who referred the child to us with the provisional diagnosis of congenital glaucoma. His physical examination was unremarkable. Examination under anesthesia revealed horizontal corneal diameter of 13.5 mm with diffuse corneal edema with multiple Haab’s striae in both eyes. His intraocular pressures were 36 mm Hg in both eyes and the lenses were clear. Gonioscopic view was hazy, but flat insertion of the iris over the poorly developed trabecular meshwork could be appreciated. Indirect ophthalmoscopy revealed asymmetric cupping of the optic of the optic nerves (0.6 OD and 0.4 OS). The posterior pole of both the eyes was otherwise normal with an incomplete view of the fundus. On ultrasound B-scan, both the eyes showed anechoic posterior segment. With this history and clinical findings, a diagnosis of bilateral primary congenital glaucoma was established, and the child underwent surgical intervention.
Current and emerging fixed combination therapies in glaucoma: a safety and tolerability review
Published in Expert Opinion on Drug Safety, 2020
Anastasios G. Konstas, Leopold Schmetterer, Vital P. Costa, Gábor Holló, Andreas Katsanos, Philippe Denis, Luciano Quaranta, Murat Irkec, Miguel A. Castejón, Miguel A. Teus, Alan L. Robin
Pediatric patients with congenital glaucoma present particular management challenges. In these cases, although the definitive treatment of choice is usually surgery [50], the use of topical glaucoma medications may be required as temporary preoperative measure, or as adjunctive postoperative therapy [51,52]. Since children have relatively small blood volume and slow drug metabolism compared to adults, the systemic absorption of topical glaucoma medications can result to higher plasma levels for a longer period, thus increasing the risk of serious systemic adverse events [53]. To date, no published studies have evaluated BTFC in a pediatric population, but this FC should not be used in children as it has already been shown that brimonidine is contraindicated in children due to its ability to cross the immature blood-brain barrier and cause potentially serious central nervous system depression and apnea [54–56].
Central Corneal Thickness and Its Association with Birth Parameters in Chinese Adolescents
Published in Ophthalmic Epidemiology, 2019
Chen-Wei Pan, Yu-Xi Qian, Hua Zhong, Jun Li, Hu Liu, Qin Chen
Central corneal thickness (CCT) is a crucial ocular parameter in the clinical diagnosis of some ocular disorders, particularly glaucoma.1 In the landmark Ocular Hypertension Treatment Study, greater CCTs were found to be associated with a higher risk of ocular hypertension while individuals with smaller CCTs were more likely to develop glaucoma.2,3 In addition to adult populations, similar findings were also observed in pediatric populations with congenital glaucoma.4,5 These findings emphasize the importance of understanding the normative ocular biometric data and novel predictors of CCT in populations of different age ranges, which is valuable for ophthalmologists regarding the clinical management of glaucoma.